CPT Code Psychotherapy 60 Minutes – A Complete Review

In the world of medical billing and mental health services, CPT Code 90837 is the designated code for psychotherapy sessions lasting 60 minutes. This Current Procedural Terminology (CPT) code plays a crucial role in insurance claims, provider reimbursements, and patient care. In this review, we will explore its importance, how it compares to other psychotherapy codes, billing considerations, reimbursement details, documentation requirements, and best practices for mental health professionals.

What is CPT Code 90837?

CPT Code 90837 is used to bill for individual psychotherapy sessions that last 53 minutes or longer. It is commonly utilized by licensed mental health professionals, including psychologists, psychiatrists, licensed clinical social workers (LCSWs), and licensed professional counselors (LPCs).

Key Features of CPT Code 90837:

• Covers a full 60-minute psychotherapy session.
• Requires face-to-face interaction between the therapist and patient.
• Used for a range of mental health conditions such as anxiety, depression, PTSD, trauma-related disorders, and more.
• Often reimbursed at a higher rate than shorter sessions (e.g., 45-minute sessions coded as 90834).
• Can be used in different therapeutic settings, including private practices, hospitals, community health centers, and telehealth sessions.
  

  

CPT Code 90837 vs. Other Psychotherapy Codes

While 90837 is the code for a 60-minute session, there are alternative CPT codes for shorter therapy sessions:

• CPT Code 90832: Psychotherapy for 30 minutes, used for brief therapy sessions where only short interventions are needed.
• CPT Code 90834: Psychotherapy for 45 minutes, a commonly used code for standard therapy sessions.
• CPT Code 90839: Used for crisis psychotherapy (lasting 60 minutes or longer) when a patient is in an acute mental health crisis requiring immediate intervention.

Choosing the correct CPT code is essential to ensure accurate billing and avoid claim denials. Insurance providers often scrutinize the use of 90837, requiring providers to justify its necessity over 90834.

Billing and Reimbursement for CPT Code 90837

Insurance Coverage and Reimbursement Rates

• Many insurance providers cover CPT Code 90837, but some may require pre-authorization before the session takes place.
• The reimbursement rate for 90837 is typically higher than 90834, making it more beneficial for therapists providing longer sessions.
• Medicare and Medicaid have specific guidelines, and providers should verify insurance policies before billing.
• Some insurance companies have a preference for 90834 and may request additional justification for 90837 claims.
• Out-of-pocket costs may vary for patients depending on their insurance plan, deductible, and co-payment policies.

Documentation Requirements

To ensure successful billing and prevent claim denials, mental health providers should document:

• The necessity of a 60-minute session compared to a shorter one.
• The treatment plan and specific therapeutic interventions used.
• Patient progress, symptom severity, and need for extended session duration.
• Any risk factors or crisis intervention that require extended time with the patient.
• Clinical justification for why a 45-minute session (CPT 90834) was insufficient.

Common Challenges and Best Practices

Challenges

• Some insurance companies limit coverage for CPT 90837 due to cost concerns.
• Pre-authorization requirements can lead to delays in claims processing.
• Reimbursement rates may vary by state, provider network, and insurance carrier.
• Insurance audits may require therapists to provide detailed records supporting the necessity of longer sessions.

Best Practices

• Verify insurance policies before scheduling longer sessions to prevent claim rejections.
• Maintain detailed clinical documentation to justify the necessity of extended sessions.
• Use billing software or third-party billing services to streamline claims processing and reduce administrative errors.
• Educate patients about potential out-of-pocket costs to prevent billing disputes.
• Stay updated on insurance guidelines and policies to ensure compliance and accurate reimbursement claims.

Telehealth and CPT Code 90837

With the rise of telehealth services, CPT Code 90837 is now frequently used for virtual therapy sessions. Insurance companies have expanded coverage for teletherapy due to increased demand for remote mental health services. However, providers should:

• Ensure compliance with HIPAA regulations when conducting telehealth sessions.
• Verify that insurance companies cover 90837 for telehealth before billing.
• Use secure, insurance-approved telehealth platforms to avoid reimbursement issues.
• Maintain proper informed consent documentation for telehealth sessions.

Final Thoughts

CPT Code 90837 is an essential billing code for 60-minute psychotherapy sessions, allowing for in-depth mental health treatment. While it provides significant therapeutic benefits, providers must navigate insurance policies and documentation requirements carefully. Understanding the billing process and staying informed about reimbursement rates can help ensure a smooth experience for both therapists and patients. By following best practices, mental health professionals can maximize their reimbursements while providing high-quality care.